AB1223 ACTIVE MILITARY ARE AT HIGHER RISK OF CHRONICITY IN LOW BACK PAIN: A CROSS SECTIONAL COMPARATIVE STUDY
Authors: W. Lahmar, R. Dhahri, O. Dhrif, M. Slouma, L. Metoui, I. Gharsallah, K. Amri, Y. Mallat, L. Nouisri
Journal: Annals of the Rheumatic Diseases (2022)

Background The incidence of low back pain (LBP) was 40.5 per 1,000 person-years in active military population and thus was comparable to the general population. Other than pain and disability, chronicity of LBP has a significant impact on work through the high rates of resulting sick leave. The Start Back Tool (SBT) questionnaire is a well-known tool used to detect patients with prognostic factors for persistent and disabling back pain. The risk of chronicity in individuals on active military duty suffering from acute back pain is yet to be explored. Objectives The aim of our study was to assess the risk of chronicity in active Tunisian military population compared to non-military controls using the SBT questionnaire. Methods Cross sectional study in which we enrolled adult patients suffering from acute back pain, who consulted the outpatient department of rheumatology in the military hospital of Tunis from January 2021 to Mars 2021. All patients had a standardized clinical examination. They completed the SBT questionnaire in the validated Arabic language version. Patients were stratified in two groups, active military group (AMG) and non-military group (NMG). Categorical variables were compared with the χ2 -test. Comparisons of the differences of continuous variables were performed by Student’s T-test. Results We included 54 patients in the active military group and 60 patients in the non-military group, epidemiologic characteristics were distributed respectively as followed: mean age was at 43+/-8 versus 53+/-13 years old (p&lt;0.001), sex ratios (F/H) were 0.23 versus 3.62 (p&lt;0.001), 54% versus 73% (p=0.033) of patients were overweight or obese, 4% versus 18% (p=0.014) of patients had type 2 diabetes, 4% versus 13% (p=0.099) of patients had dyslipidaemia while 9% versus 20% (p=0.108) of patients had hypertension. Active military group patients had significantly higher proportions of high risk SBT scores than non-military patients 50% versus 22% (2.27 risk ratio 95% CI 1.47 to 3.08; p=0.002), with total mean of scores significantly higher in the active military group 5.81 (95% CI 5.33 to 6.29) versus 4.85 (95% CI 4.43 to 5.27), p=0.014. Active military group patients scored significantly higher on the psychological SBT sub-score with a mean of 3.02 (95% CI 2.8 to 3.24) versus 2.38 (95% CI 2.07 to 2.7) p=0.032, they were more susceptible to express low mood 53% versus 35% (1.51 risk ratio 95%CI 1.13 to 1.89; p=0.044). There was no significant difference in expressed anxiety 69% versus 55% (p=0.139), catastrophizing thoughts 57% versus 47% (p=0.252) and avoidance beliefs 72% versus 60% (p=0.170) though all of these parameters were more prevalent in the active military group. Conclusion Though NMG patients had more classic low back pain risk factors such as age and obesity, this did not prevent the AMG to show higher trends toward chronicity via SBT scores. This is to our knowledge the first study to assess the high risk of persistent disabling back pain using the SBT in a Tunisian military population. The implementation of risk stratification for patients with low back pain in routine military health may improve physical function and time off work, sickness certification rates and reductions in healthcare costs compared to usual non-stratified care. Disclosure of Interests None declared